2003-481 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761.8256
CERTIFICA.TE OF COMPLIANCE
Permit Number: P20030481 Date Issued: Friday,June 27,2003
This is to certify that work requested to be done as shown by Permit Number P20030481
has-been completed.
Tax Map Number: 523400-308-016-0001.041.000-00K
Location: 56 PINEWOOD Rd
Owner: GEORGE&MARGARET DRUM
Applicant: GEORGE&MAR.GARET DRUM
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TO oli UE s RY
"0 4
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030481 Application Number: A20030481
Tax Map No: 523400-308-016-0001-041-000-0000
Permission is hereby granted to:- GEORGE&MARGARET DRUM
For property located at: 56 PINEWOOD Rd
in the Town of Queensbury,to'construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: GEORGE&MARGARET DRUM Septic Alteration Residential
56 PINEWOOD Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2003-481
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,June 26,2004
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.).
Dated at the To ueensb r day,June 26,2003
SIGNED By for the Town of Queensbury.
Director of Building&Code nforcement
Application for Perinit—Septic Disposal System
i
Towirof QficiMsbuly 742 8(?j,1Zoad Queensbuty,NJ' 12804 (518)1761-8256
1. OWNER INFORMATION:-
................................
Office Use
Location bf installation: S/0 to"Al-,e&, i
Idle Ponnit No.0
Tax Map No. Fee Paid "a's- 01�
Owner's Name: a- D/e ................................................ ........................... ................ ..........
Address:
2 'INSTALLER'S NAME e.—I a;c Ze PHONE NO. 7 961—7-z-s
3. RESIDENCE INFORMATION; (circle year of dwelling, indicate ff bedroont(s) and multiply 11 of
bedrooms with applicable gallons per bedroont to equal total dailyflow)
You of H-auspo Na. of Bedroom x Computation = Total Daily Flow
1980 or older x 150 gni/bdrin =
1980- 1991 X 130 gallbdrun
1991 -present X 110 ga Vbdrin
Garbage Grinder Installed yes no
Spa or Wbirlpool Installed yes 110
4. PARCEL INFORMATION: (circle applicable inform Pion-&indica
3,3 A W
loxmol d-W-ao;L-
I Y-Y-
I?olllllg well
steep slope Clay
—Yo slope other fi-Prn arty septic-system
depth: abs'orlition is
other
Percolation Test: (To be completed by licensed pro engineer or architect)
Rate: mintite per Inch
5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by h licensed
professional cligiricer or irchilect (tailless installed in a Planning gallons to file size
',13oard ipproved%ubdivisiori), Add 250 g,
or file tcpfic tank and leach field for cacti Uatbage Uritider, Spa or Whitlilool 'I't1b.
SeptloTank. /000 gallon (miry. size 1,000gal.)
Tile Field: -each trench, Jt. Total System Lerigth:,, 0
Seepage Pit(s): number qf--j6!1j6 size VJI each: ft. by_ft.
Size or Stone to be taxed: fl -ttIA— tlejjWs or
Bed System Size: X
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks:, Size of each: gallons, TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be"inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION,FOR RESPONSIBLE PERSON (please read)
Tar your protection. pfe-IsC note that pursuant to Section 136-29 or time Code of tho Town
of Queortsbtiry, any peravilt or approval g,r.11sted which is based tivotv•or is granted in
r?ti,,%co triiqrelyrescirtntioti or (-nittire to ril-rake.1 material rhct or
carcutristatica known by or out belinirornet applicant, shall be void.
I have rand the regulations wills respect to this application and agree to abide by these amid-all
requirements of the Town of Queettsbory Sanitary Sewage Disposal Ordinance.
XPL
slqfiature of rei-pohfifble:person Date
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received-
Queensbury Bu ilding&Code Enforcement Arrive: amj/ ,,,tpart:'( _r am/pin
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:
NAME: PERMIT NO.:
LOCATION: INSPECT ON:
( C2
RECHECK:
/Z Comments and/or diagram
Soil Type: 6ayid ' m lay
Type of Water(Mun cipgi/Well Water
Waterline sea) tion d_ietance ft.
Well separation ai—sla—nce ft.
Other,wells:
Absorption Field: Total length ft.
-Length of each trench ft.
Depth of trenche
.Size of Stone X,,o tjele,6!?4�
Seepage Pits: Number'
Size: x
Stone Size:
Piping Si2;e. Type/—
ft
Building to tankCq
Tank to Distribution Box
Distribution Box to Field l Pit tt
Opening Sealed: Y/NI Partial
Location/Separations A/
Foundation to tank
Foundation to absorption ft.
Separation of Pits t.
Conforms as_per Plot Plan
Location of Sy
on Property:
Fro t Rear Left Side Right Side
Middle ront Middle Rear
System Use Stat
Approved
Partial Approved and needs to be re-inspected,please call the'Building&Codes Office
Disapproved
LASuellerningway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
"! have se -
en or observed, or believe !saw evidence
V%'0 a!! objects s>.;ch as houses �r
�` shown on this docunjent, ! also!j�trees, fences, etc., of,
,311 2 2003 per, present that ! have
measured th ances set for
TOWN or 0 C)COt)F- on the diagram.
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